Tibiocalcaneal arthrodesis for the management of severe ankle and hindfoot deformities

M. S. Myerson, Richard Alvarez, P. W.C. Lam

Research output: Contribution to journalArticle

78 Citations (Scopus)

Abstract

Purpose: The purpose of this investigation was to evaluate the outcome of tibiocalcaneal arthrodesis using an adolescent condylar blade plate for severe ankle and hindfoot deformities. Materials and Methods: We retrospectively reviewed the records of patients managed at our institutions between 1989 and 1996 whose tibiocalcaneal arthrodeses were performed with adolescent condylar blade plates and allograft bone. In these 30 patients (14 men, 16 women; average age, 53 years), the etiologies of the nonbraceable deformity included: diabetic neuroarthropathy with talar fragmentation and resorption (26), inflammatory arthritis (3), and posttraumatic avascular necrosis of the talus with collapse (1). Due to the severity of the deformity in 28 of these patients, the alternative treatment would have been amputation. Thirteen patients had undergone previous surgeries, eight had documented osteomyelitis, and 13 had ulcers ranging from 2 to 27 mm. At surgery, the remnants of the talus were removed. Morcellized bone graft mixed with tobramycin/vancomycin powder was inserted into the arthrodesis site and then fixed with a rigid plate. Intravenous antibiotics, followed by oral antibiotics, were given until wound healing and suture removal. Follow-up averaged 48 months (19 to 112 months). Results: Tibiocalcaneal fusion was achieved in 28/30 patients at an average of 16 weeks (12 to 18 weeks). Complications occurred in seven patients: two developed stress fractures of the tibia at the proximal end of the blade plate, three had superficial cellulitis that resolved with antibiotic therapy, and two had nonunions. Conclusion: Tibiocalcaneal arthrodesis using an adolescent condylar blade plate and allograft bone can be a successful procedure in the patient with severe neuropathic ankle deformity and can achieve a stable plantigrade foot for limited community ambulation with relatively few complications.

Original languageEnglish (US)
Pages (from-to)643-650
Number of pages8
JournalFoot and Ankle International
Volume21
Issue number8
DOIs
StatePublished - Jan 1 2000
Externally publishedYes

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Arthrodesis
Ankle
Bone Plates
Talus
Anti-Bacterial Agents
Allografts
Stress Fractures
Tobramycin
Cellulitis
Osteomyelitis
Vancomycin
Tibia
Amputation
Powders
Wound Healing
Sutures
Ulcer
Walking
Arthritis
Foot

All Science Journal Classification (ASJC) codes

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Tibiocalcaneal arthrodesis for the management of severe ankle and hindfoot deformities. / Myerson, M. S.; Alvarez, Richard; Lam, P. W.C.

In: Foot and Ankle International, Vol. 21, No. 8, 01.01.2000, p. 643-650.

Research output: Contribution to journalArticle

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